| NPI | 1467075812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 346701) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NY 530437) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2020-10-14 |